Heterosexual Transmission of HIV -- 29 States, 1999-2002

Morbidity and Mortality Weekly Report. 2004;53(6) 

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Worldwide, the majority of human immunodeficiency virus (HIV) infections result from heterosexual transmission.[1] To characterize heterosexual transmission of HIV infections in the United States, CDC analyzed data for 1999-2002 from the 29 states* that have met CDC standards[2] for name-based HIV/acquired immunodeficiency syndrome (AIDS) reporting for ≥4 years†. This report summarizes the results of that analysis, which indicated that heterosexually acquired HIV infections represented 35% of all new HIV cases; 64% of heterosexually acquired HIV infections occurred in females, and 74% occurred in non-Hispanic blacks. To decrease the number of new heterosexually acquired HIV infections, especially among certain minority populations, culturally targeted education and prevention programs should be provided, and barriers to HIV care and prevention services should be removed.

The analysis included persons aged ≥13 years with HIV; infections were categorized as either heterosexually acquired§ or nonheterosexually acquired. Heterosexually acquired HIV infections were further categorized as diagnosed with AIDS (i.e., during the same calendar month) or diagnosed without AIDS. New diagnoses of HIV infections were examined for 1999-2002. Data were adjusted for reporting delays, and HIV-exposure data were adjusted for reclassification of cases initially reported with no mode of exposure into categories according to historical patterns of reclassification.[3] CDC calculated confidence intervals (CIs), taking into account adjustments for reporting delays and reclassification to exposure categories, and variance estimates were derived from monthly data submissions to CDC.[4]

During 1999-2002, a total of 101,877 HIV infections were diagnosed in the 29 states and reported to CDC, including 36,084 (35%) acquired through heterosexual contact ( Table ). Among states, the median prevalence of heterosexually acquired HIV infections was 27% (range: 13%-47%).

The proportion of females was greater among persons with heterosexually acquired HIV infections (64%; 23,205 of 36,084) than the proportion of females among persons exposed through injection-drug use, blood products, transfusions, and undetermined modes of exposure (36%; 6,661 of 18,732). Among age groups, prevalence for heterosexually acquired HIV infections was greatest (35%) among persons aged 30-39 years.

Non-Hispanic blacks accounted for 26,748 (74%) of persons with heterosexually acquired HIV infections. A total of 5,257 (15%) were non-Hispanic white; 3,498 (10%) were Hispanic; and <1% were Asian/Pacific Islander or American Indian/Alaska Native. By comparison, among persons with nonheterosexually acquired HIV infections, non-Hispanic blacks accounted for 29,607 (45%), and non-Hispanic whites accounted for 26,731 (41%). During 1999-2002, an overall increase in heterosexually acquired HIV infections from 8,925 (95% CI = 8,606-9,243) in 1999 to 9,156 (95% CI = 8,713-9,600) in 2002 was not statistically significant.

Among the 36,084 persons with heterosexually acquired HIV infections, 7,395 (20%) ( Table ) received a concurrent diagnosis of AIDS. Diagnosis of HIV/AIDS was more common among males (25%; 3,223 of 12,879) than among females (18%; 4,172 of 23,205).

Females accounted for 89% of heterosexually acquired HIV infections among persons aged 13-19 years (Figure 1). Females also accounted for 70% of such cases reported among non-Hispanic whites, 64% among non-Hispanic blacks, and 56% among Hispanics (Figure 2).

*Alabama, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
†Five additional states (Alaska, Georgia, Kansas, New York, and Texas) have implemented name-based HIV/AIDS reporting that meets CDC standards. Pennsylvania also has implemented such reporting, but only in areas outside Philadelphia.
§ An HIV infection was categorized as heterosexually acquired if a patient reported specific heterosexual contact with a person with HIV infection or with a person at increased risk for HIV infection (e.g., an injection-drug user).

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